Healthcare resource utilization and costs among patients with relapsed and/or refractory multiple myeloma treated with proteasome inhibitors in real-world clinical practice in Germany

Figures & data

Table 1. Characteristics of patients with RRMM receiving a PI during 2L or 3L treatment.

	2L treatment				3L treatment
	Total	BTZ-based regimen	CFZ-based regimen	IXA-based regimen	Total	BTZ-based regimen	CFZ-based regimen	IXA-based regimen
n (%)	219 (100)	92 (42)	106 (48)	21 (10)	83 (100)	12 (15)	51 (61)	20 (24)
Mean age at diagnosis, years	67	72	64	64	67	65	68	65
Male, n (%)	152 (69)	65 (71)	71 (67)	16 (76)	58 (70)	8 (67)	36 (62)	14 (24)
ECOG performance status 0–1 at index PI line, n (%)	118 (54)	39 (42)	64 (60)	15 (71)	48 (58)	7 (58)	29 (60)	12 (60)
ECOG performance status 2 at index PI line, n (%)	100 (46)	52 (57)	42 (40)	6 (29)	34 (41)	4 (33)	22 (43)	8 (40)
ECOG performance status 3–4 at index PI line, n (%)	1 (<1)	1 (1)	0 (0)	0 (0)	1 (1)	1 (8)	0 (0)	0 (0)
ISS stage I^a at diagnosis, n (%)	15 (7)	4 (4)	9 (9)	2 (10)	4 (5)	0 (0)	2 (3)	2 (10)
ISS stage II^a at diagnosis, n (%)	101 (46)	35 (38)	58 (55)	8 (38)	28 (34)	4 (33)	13 (26)	11 (55)
ISS stage III^a at diagnosis, n (%)	94 (43)	48 (52)	35 (33)	11 (52)	48 (58)	8 (67)	33 (65)	7 (35)
Cytogenetic information del17p, n (%)	98 (45)	22 (24)	62 (59)	14 (67)	43 (52)	6 (50)	26 (51)	11 (55)
Cytogenetic very high risk del17p (%)^b, n (%)	11 (11)	2 (9)	8 (13)	1 (7)	8 (18)	0 (0)	5 (19)	3 (27)
Cytogenetic information t(4;14), n (%)	91 (42)	21 (23)	59 (56)	11 (52)	44 (53)	6 (50)	27 (53)	11 (55)
Cytogenetic very high risk t(4;14) (%)^b, n (%)	15 (17)	5 (24)	7 (12)	3 (27)	4 (9)	1 (17)	3 (11)	0 (0)
Cytogenetic information 1q21, n (%)	89 (41)	21 (23)	58 (55)	10 (48)	40 (48)	5 (42)	25 (53)	10 (49)
Cytogenetic very high risk 1q21 (%)^b, n (%)	14 (16)	0 (0)	14 (24)	0 (0)	7 (16)	0 (0)	4 (16)	3 (30)
History of neuropathy, n (%)	41 (19)	18 (20)	21 (20)	2 (10)	0 (0)	0 (0)	0 (0)	0 (0)
History of deep vein thrombosis, n (%)	10 (5)	4 (4)	6 (6)	0 (0)	17 (21)	3 (25)	9 (18)	5 (25)
History of significant cardiovascular disease, n (%)	37 (17)	21 (23)	11 (10)	5 (24)	15 (18)	3 (25)	8 (16)	4 (20)
Received SCT previous to index date, n (%)	72 (33)	13 (14)	52 (49)	7 (33)	40 (48)	7 (58)	22 (43)	11 (55)
Mean time from diagnosis to index PI initiation, months	25	20	28	33	40	46	34	50
Mean time on current PI regimen, months	9	8	10	9	9	8	9	10
Patients on ongoing PI treatment at end of study, n (%)	146 (67)	52 (57)	82 (77)	12 (57)	59 (71)	8 (67)	33 (65)	18 (90)

Representative RRMM cohorts with notable numbers of bortezomib-, carfilzomib- and ixazomib-based 2L and 3L treatment showing respectable mean times of 2L and 3L treatment periods of 9 months.

Abbreviations. 2L, second-line; 3L, third-line; BTZ, bortezomib; CFZ, carfilzomib; ECOG, Eastern Cooperative Oncology Group; ISS, International Staging System; IXA, ixazomib; PI, proteasome inhibitor; RRMM, relapsed and/or refractory multiple myeloma; SCT, stem cell transplant; t(4;14), 4;14 translocation.

^aISS score was unavailable for 4% of the study patients.

^bOnly number of patients tested for cytogenetic abnormalities was accounted for in the denominator.

Figure 1. Treatment patterns for patients with RRMM receiving a PI in second or third line. (A) Treatments administered during first and second line for patients receiving a PI in second line (n = 219). (B) Treatments administered during first, second and third line for patients receiving a PI in third line (n = 83). PI-based regimens administered for the treatment of RRMM in real-world clinical practice in Germany are in accordance with national and international treatment guidelines. Abbreviations. BTZ, bortezomib; CFZ, carfilzomib; IXA, ixazomib; LEN, lenalidomide; PI, proteasome inhibitor; RRMM, relapsed and/or refractory multiple myeloma.

Table 2. Mean monthly direct costs (in Euros [€]) associated with PI-based regimens in patients with RRMM.

	2L treatment				3L treatment
	Total (n = 219)	BTZ-based regimen (n = 92)	CFZ-based regimen (n = 106)	IXA-based regimen (n = 21)	Total (n = 83)	BTZ-based regimen (n = 12)	CFZ-based regimen (n = 51)	IXA-based regimen (n = 20)
Monthly planned hospitalizations, €	388	497	281	444	334	400	316	342
Monthly unplanned hospitalizations, €	242	358	113	391	190	311	237	0
Monthly total hospitalizations, €	630	855	394	835	524	710	552	342
Monthly scans and procedures, €	64	59	59	116	54	53	53	58
Monthly total concomitant medications, €	208	202	232	121	218	87	236	252
Monthly total anti-myeloma drugs, €	7,022	3,705	9,199	10,566	9,896	11,448	7,957	13,908
Monthly total planned resources^a, €	7,683	4,463	9,771	11,247	10,502	11,988	8,562	14,559
Monthly total unplanned resources^b, €	242	358	113	391	191	311	237	0
Monthly total direct costs, €	7,925	4,821	9,884	11,638	10,693	12,299	8,799	14,559

Substantial costs of 2L and 3L treatment in all groups, mostly driven by anti-myeloma drug costs.

Abbreviations. 2L, second-line; 3L, third-line; BTZ, bortezomib; CFZ, carfilzomib; IXA, ixazomib; PI, proteasome inhibitor; RRMM, relapsed and/or refractory multiple myeloma.

^aPlanned resources comprised those expected within routine treatment practice associated with PI-based treatment.

^bUnplanned resources included unexpected events requiring medical resources that were not considered in normal monitoring or treatment. Cost drivers are highlighted in bold.

Figure 2. Planned and unplanned hospitalizations in patients with RRMM receiving a PI by best response achieved. (A) Mean monthly costs (Euros). (B) Mean number of days in hospital per month. Cost expenditures were much decreased in responders vs non-responders. Data are shown from a total of 219 patients in second line. Of those, one-third of patients had a planned hospitalization (n = 64) and 5% an unplanned hospitalization (n = 11). Error bars indicate standard errors. Abbreviations. CR, complete response; PD, progressive disease; PI, proteasome inhibitor; PR, partial response; RRMM, relapsed and/or refractory multiple myeloma; SD, stable disease; VGPR, very good partial response.